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PM2C: Therapeutics and Patient Care: Summer > Cardiovascular: coronary heart disease > Flashcards

Cardiovascular: coronary heart disease Flashcards

1
Q

Define what atherosclerosis is?

A

Deposition of fatty plaques in coronary arteries

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2
Q

What can atheroma or plaques do?

A
  1. Narrow coronary artery as the fatty deposits form plaques
  2. Rupture or cause further narrowing or block
  3. Thrombus can occur when plaques rupture and block various places in heart
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3
Q

Describe what angina is?

A
  1. A symptom of coronary heart disease
  2. Insufficient oxygen supply to myocardium muscle of the heart
  3. Pain characterised by radiating pain in chest, arm or neck
  4. Pallor (paleness), sweating and breathlessness
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4
Q

Describe what stable angina is?

A
  1. Predictable pain on exertion such as walking to the shops
  2. Caused by atheroma mainly (plaque)
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5
Q

Describe what unstable angina is?

A
  1. Pain on little exertion or rest (serious, things get worse)
  2. Caused by atheroma or plaque rupturing to create a thrombus blockage in the artery
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6
Q

What is variant angina?

A

Artery spasms associated with atheroma

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7
Q

What is microvascular angina?

A
  1. Ladies suffer from this more

2. Pain often more severe and may not respond to normal treatments

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8
Q

Describe what myocardial infarction is and what the aim of treatment is?

A
  1. Mainly known in layman term as “heart attack”
  2. Caused when a atheroma or plaque ruptures to create a thrombus which causes blockage in artery
  3. Leads to less oxygen in required region of the heart
  4. Apoptosis (programmed cell death) or Necrosis (cells exploding)
  5. Treatment utilised to restore blood supply, prevent re-occulisation and minimise cell death
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9
Q

What are the symptoms and diagnosis of myocardial infarction?

A
  1. Symptoms
    - Similar to angina (pallor, pain)
  2. Diagnosis
    - Patient history or chest pain, angina and unstable angina
    - ECG changes
    - Cardiac biomarkers (TROPONIN found in blood)
  3. If troponin is more than 99 percentile then its classified as Myocardial infarction
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10
Q

When doing a ECG recording to diagnose myocardial infarction, what is it classed as when the ST levels are elevated or not elevated?

A
  1. STEMI (more serious)

2. NSTEMI (normal ST level)

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11
Q

What are the drugs and methods that are useful in ischemic heart disease?

A
  1. Acute: Organic nitrates
  2. Prophylactic (responding to pain)
    - Organic nitrates
    - Calcium antagonists
    - Beta blockers (most important)
    - Anti platelet agents and ACE inhibitors
    - Statins employed
  3. Surgical Interventions
    - MY revascularisation (angioplasty) for angina as well
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12
Q

Give examples of organic nitrates and what they are used for?

A
  1. Glyceryl Trinitrate (GTN) commonly used and longer acting compared to Isosorbide mononitrate
  2. Relaxation of smooth muscle by releasing Nitric Oxide (NO) and generation of cGMP
  3. Dilates coronary arteries to redistribute blood to ischaemic (low in blood) regions
  4. Reduce cardiac oxygen consumption
  5. Prevents and relieves coronary spasms
  6. Affect veins by reducing amount of blood going away from heart
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13
Q

What are the problems that can occur from using organic nitrates?

A
  1. Prone to tolerance development (avoided by nitrate free periods overnight)
  2. Action is short and so is shelf life
  3. GTN spray or sublingual tablet is rapidly absorbed in blood stream
  4. Cannot be swallowed due to first pass metabolism
  5. Isosorbide lasts longer as metabolised and absorbed more slowly
  6. Side effects:
    - Flushing
    - Headache
    - Postural hypotension
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14
Q

How does an organic nitrate work in the heart?

A
  1. Dilates the collateral artery which allows blood to flow across all regions of the heart even if one area gets blocked
  2. This leads to a balance of blood to ischaemic area and normal area of myocardium
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15
Q

What is dipyridamole used for?

A
  1. Stress test in coronary artery disease

2. Vasodilator

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16
Q

How are calcium channel blockers used for coronary heart disease?

A
  1. Used as a vasodilator to dilate the collateral arteries
  2. Reduces oxygen demand of heart and dilates coronary arteries
  3. Examples: Verapamil and Diltazem and Nifedipine (avoid use in angina)
17
Q

What were beta blockers originally designed for and their function?

A
  1. Treatment of angina pectoris
  2. Beta 1 specific blockers are atenolol and metoprolol
  3. Reduces the oxygen demand of the heart by inhibiting sympathetic drive to heart
  4. This leads to pain relief as well as heart doesn’t need to contract as hard
18
Q

What is the common misconception students have about beta blockers?

A
  1. They dilate the blood vessels in the heart

2. They merely reduce the sympathetic drive in the heart so therefore less oxygen is needed to drive it

19
Q

How do you manage stable angina?

A
  1. Organic nitrate for pain relief
  2. Beta blockers
  3. Combination of beta blockers with calcium channel blockers for resistant angina
  4. Secondary prevention
    - Asprin low dose
    - Statin to stabilise atherosclerotic plaques
    - ACE inhibitor to reduce preload on heart
20
Q

How do you treat unstable angina and NSTEMI?

A
  1. Oxygen (only if hypoxia (deficient oxygen) is present)
  2. Organic nitrates such as GTN for pain relief (if inefficient, use morphine)
  3. Dual anti-platelet theory
    - Aspirin alongside Clopidigrel or prasugrel
  4. Beta blockers and calcium channel blockers to both reduce oxygen demand of heart
  5. Calcium channel blockers relax coronary blood vessels and only used in patients who are resistant to beta blockers
21
Q

What is the initial treatment for STEMI and long term treatment for STEMI and NSTEMI?

A
  1. Fibrinolytic drugs such as streptokinase and alteplase for STEMI
  2. Prophylaxis for NSTEMI or STEMI
    - Statin, aspirin, ACE inhibitor and beta blocker
    - STEMI add clopridogrel (even warfarin)
    - Verapamil or diltiazem replace beta blockers
  3. Surgery: done before secondary prevention
22
Q

What is surgical intervention for Ischemic heart disease coronary bypass?

A
  1. Vein is taken from leg or arm
  2. Graft that vein to the aorta to where the heart occurs
  3. Site of blockage no longer a problem
23
Q

Describe what surgical intervention for Ischemic heart disease angioplasty is and how it works?

A
  1. Stents are placed into narrow femoral artery for problems such as angina
  2. Prevent Myocardial infarction and decrease proliferation of smooth muscle cell
  3. This occurs when a catheter is placed into an artery
  4. Another catheter is placed over it which inflates a balloon like stent in the blocked required area
  5. This increases arterial diameter and blood flow, it remains there after the blood vessels heal over it

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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